A Quick and Easy Solution for Second Mattress Requests!

The Elmore County Jail in Mountain Home, Idaho

I have a quick ‘n easy solution for those pesky requests for a second mattress that plague all correctional facilities.  But before I get to that, though, there are two important points to consider in any discussion about second mattresses in correctional facilities.

First, providing inmates with mattresses, like inmate clothes and toiletries, is the purview and duty of the correctional officers, not the medical staff.  What this means is that when an inmate asks for a second mattress, the question being put to us is this:  Is there a medical need for this patient to have a second mattress?  This is critically important.  The inmate would prefer to frame the question differently, something like this:  “The correctional officers only issued me one mattress, but you can over-rule them and authorize me to have a second mattress.  Will you do me this favor?”  This is a totally different question than “Does this patient have a medical need for a second mattress.”

Secondly, having a second mattress is a status symbol inside the correctional community.  When an inmate receives a benefit that other inmates do not, he gains status and prestige.  Sometimes this motivation is as important for an experienced inmate as is the extra comfort of a second mattress.  I believe that if a jail provided two mattresses to every inmate in the facility, there would be requests to medical for three mattresses.  (Pretty soon inmate beds would rival “The Princess and the Pea!”) So when we grant inappropriate requests for second mattresses, we are conferring status on the inmate in question.  And we are denying status to those who we refuse.  This also, in my mind, is important to consider.

So now to the main topic of the day:  What constitutes a “medical need” for a second mattress?  In my opinion—there are none!  Zero.  Nada.  There is no medical need ever for a second mattress.  I challenge anyone to find a reference in any medical literature saying that second mattresses are a treatment for anything.  For example, a common reason given by inmates requesting a second mattress is that they have chronic back pain.  However, if you pull out any medical textbook that deals with the treatment of chronic back pain, you will not find second mattresses mentioned in any.  Go ahead! Look!

I will acknowledge that there are patients who have a medical need for a hospital bed.  For example, we recently had a quadriplegic in one of my jails.  He didn’t need a second mattress, he needed a hospital bed.  Likewise, a patient with congestive heart failure who needs to sleep with the head of the bed elevated needs a hospital bed.  A second mattress will not do the trick.  I can think of many examples of medical conditions that would require a hospital bed, but I can’t think of a single instance when a second mattress would be an appropriate substitute.

Once you accept this premise—that there is no medical need for a second mattress–it ceases to be a medical concern.  Such requests will no longer be routed through medical.  The Correctional Officers can deal with requests for a second mattress.  If they want to give an inmate a second mattress out of the kindness of their hearts, they may, but it is not a medical issue.  Some facilities have opted to grant second mattresses as a comfort item to, say, women in the third trimester of pregnancy.  Or to the elderly.  This is fine, but this is a humanitarian gesture, not a medical need.

In my experience, once the policy that no one gets a second mattress for medical reasons becomes established in a facility, the requests for a second mattress fade away almost to nothing.  Also, grievances relating to second mattresses will disappear, since a common cause of grievances is perceived unfairness.  If you grant second mattresses to some but not others, the ones who do not get them will feel slighted.  If everyone is treated the same, i.e. no second mattresses for anyone, inmates will not feel that they have been treated unfairly.

This policy has worked well in my facilities and in a few others I have heard of (notably the Maricopa County Jail in Phoenix, where I was first turned on to this concept).  I heartily recommend it.

17 thoughts on “A Quick and Easy Solution for Second Mattress Requests!

  1. Christina RN

    good post Jeff, I agree… we actually did a test months back at Bingham to see if two mattresses were more comfortable than one…answer NO, its not more comfortable, only higher off the ground and adds to the possibility of rolling off the metal bunk and causing me to have to come in during the middle of the night lol.

    Reply
    1. Christin Lowry

      2nd mats were deemed medically unnecessary at my facility a few months back. Before that time the guidelines were 1. pregnant 2. end stage cancer 3. end stage of dying or extreme cases. Otherwise at this point NO ONE gets a 2nd mattress and I have not had any complaints other than people re-entering the facility prior to these new rules and requesting they get their “2nd mattress” as they did the last time they were in county.

      This situation actually occurred due to low supplies of mattresses for incoming inmates and the fact they had to replace some due to wear and tear; medical finally deemed it unnecessary for everyone and it’s squashed all of those issues!

      Reply
      1. Jeffrey Keller MD Post author

        Thanks for the comment, Christin! The “Second Mattress” situation can become a real time-consuming problem for correctional practitioners–if you let it. When no one gets a second mattress, grievances go down and productivity goes up, because we have more time for actual medicine!

        Reply
  2. Michael Brewer RN, Inmate Healthcare Supervisor, Ada County Sheriff Office

    Once your facility comes up with a specific policy the key is the enforcement by the medical staff. Consistency in responses.

    Reply
    1. Jeffrey Keller Post author

      I agree, Mike. It does no good when deputies tell inmates, “the only way you can get a second mattress is if medical says you can.” Everyone needs to sing the same song–no second mattresses!

      Reply
  3. LJMOCJ

    We supply a second mattress to inmates with seizure disorders, not to lay on the bed, but to keep on the floor in the event of a seizure.

    Reply
    1. Christin Lowry

      Inmates with documented seizure episodes are qualified as lower level/lower bunk and we do not often experience situations where inmates are falling from their bunk (1′ ft) to the floor enough to warrant a 2nd mat for these reasons. This may be in part due to the fact we have a medical infirmary and will send these types of inmates out to a hospital to stabilize if they are having seizures this frequently.

      Reply
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  5. Donna Juliano RN

    I posted a sign in my exam area that states, “We have no extra mattress, don’t bother asking”. I haven’t been asked since it was put up.

    Reply
    1. Jeffrey Keller Post author

      And probably get no more grievances, either! Grievances occur often because of perceived unfairness. If inmate A gets a second mattress but inmate B was denied, inmate B will feel he was treated unfairly and will write a grievance. If everyone is treated the same, as at your jail, grievances go down!

      Reply
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  9. Gcs15

    What about sleep apnea? I used to work at a psych hospital on the adult dual diagnosis floor and we gave extra pillow to people with sleep apnea. How do you handle it in prison?

    Reply
    1. Jeffrey Keller MD Post author

      I personally do not believe that an extra pillow is an appropriate therapy for sleep apnea. Also, extra pillows have value in jail economy. An extra pillow is a sign of status and can be traded for favors. Also, via the principle of Fairness, if you give an extra pillow to one inmate who says “I have sleep apnea,” then you are obligated to give an extra pillow to every inmate who says this.

      The appropriate therapy for true sleep apnea is a CPAP machine.

      One jail I know of found another slick alternative way to extra pillows used to elevate a patient’s head: big foam wedges. These had no value as status or to trade. And it was easy for the deputies to see if a patient who had been given one was really using it.

      Reply
  10. Joyce fishman

    Hi Jeff, With all due respect to your profession i disagree on several points you made. Although I do agree with possible problems with one prisoner being given an extra mattress and another not given one. I do see that the answer is a medical one and shouldn’t be left up to the correctional guard.
    I was diagnosed with severe joint pain in my lower back. A good mattress or not enough padding makes all the difference between a restful sleep or not. I have slept on a mattress so inadequate that i didn’t sleep at all. My son in a local correctional facility has lower back pain and mentioned to me that he could feel the metal on the bed because the mattress is so under padded that he added 2 blankets under the sheet, but the correctional officers took them on a surprise inspection. What i understand is Correctional Officers are trained to insure safety and do not make medical decisions. Just because the mattress issue is not in a medical book doesn’t mean it doesn’t exist. I assure you it makes an incredible difference in rest or no rest.
    I was looking for an answer for my son and came across your post. I wanted you to have the information for you might reconsider the next time someone complains about their back pain.
    Best regards,
    Joyce Fishman

    Reply

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